Individual
DR. JOHN CHRISTOPHER JACOBS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5171 S COTTONWOOD ST STE 740, MURRAY, UT 84107-5705
(801) 507-9700
Mailing address
5171 S COTTONWOOD ST STE 740, MURRAY, UT 84107-5705
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01080994A
IN
207P00000X
Emergency Medicine Physician
Primary
117034591205
UT
390200000X
Student in an Organized Health Care Education/Training Program
11019354A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300017612
—
IN
Enumeration date
06/13/2017
Last updated
08/17/2020
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